NOTICE OF ENROLLMENT IN IMRF

Transcription

1 NOTICE OF ENROLLMENT IN IMRF IMRF Form 6.10 (Rev. 11/05) How to complete this form Employment Information PLEASE PRINT OR TYPE ALL ANSWERS The Aulhorizcd Agent completes questions 9through 15. Refer to Section 3ofthe Manualfor AuthorizedAgents for information on eligibility requirements for participation in IMRF. Question 1 - Member name The name entered in Box I should be the name used to report the member's earnings to IMRF. Using the same name will better ensure that the member receives proper credit for contributions made and service earned. Questions 2-10 Rnter the requested information. Question 11 Enter the requested information for each position the member will hold. If the date employed is different than the participation date (the date the member began working in the position(s) qualified under the annual hourly standard), please explain in the space provided. The Illinois Pension Code docs not recognize reasons such as probationary, temporary or trial work period. Entera detailed explanation why the memberwas not enrolled immediately. Refer to Section 3 of the Manual forauthorized Agents for more information regarding participation requirements. Full Time/Part Time applies only toslep. Circle the appropriate response. Question 12 Check"yes" if the memberis in a position that requires at least six months of consecutive service but less than 12 in any 12- month period. OR Check"yes" if the member's earnings will be reported to IMRF other than on a monthly basis, e.g. annually, quarterly, etc. If answered"yes" to either question and seasonal employer is not a school district, park district, or recreationassociation, or if the employee will be paid irregularly(applies only to elected officials) check the months the employee will not be paid. Question 13 A If the member is a police chief eligible for transfer into the Sheriff's Law Enforcement Personnel plan (SLEP), please complete and attach IMRF Form 6.22, "Election of Police Chief to Participateas SLEP Member."(Refer to Section 3 of theslep supplement to the Manualfor Authorized Agentsfor information on SLEP eligibility requirements.) Question 13 B Check "yes" if the member has been sworn in to perform police duties. (Refer to Section 3 ofthe Manual for AuthorizedAgents for eligibility requirements.) IMRF Form 6.10 (Rev. 11/05) Question 13 C Check "yes" if themember will perform fire protection duties. (Refer tosection 3 of the Manual forauthorized Agents for eligibilityrequirements.) Question 13 D and 14 If the member is an elected official, appointed to elected office, or is a city hospital worker, please complete and attach IMRF Form 6.21, "Election to Participate." Question 15-COUNTY EMPLOYERS ONLY If the employer is a countyand the member is/was elected or appointed to elected office, complete question 15. If "yes" is checked and the member elected to participate in the Elected County Official plan, complete and attach IMRFForm 6.2IB, "Electionof Elected County Official to Participate in ECO." AUTHORIZED AGENT PLEASE NOTE: Social Security card/number Tape a copy of the member's Social Security card in the box. IMRF uses Social Security numbers to identify members' accounts and files. Social Security numbers are also used on IRS statements issued by IMRF. If the name in Box 1 is not the same as shown on the Soc**1 Security card, the member should take evidence to substantiate the changeof name to a local Social Securityoffice so a new card may be issued. Once issued, please forward a copy to IMRF. If the member does not have a copy of his/her Social Security card, IMRF will use the Social Security number entered on this form. Any IRS penalties that result from an incorrect Social Security number will be the responsibilityof the IMRF employer. If the member obtains a Social Security card after being enrolled, please forward a copy to IMRF. When calling When calling IMRF regarding enrollment, ask for the Enrollment Auditor. Illinois Municipal Retirement Fund 2211 York Road, Suite 500, Oak Brook Illinois Service Representatives ASK-IMRF ( )

2 NOTICE OF ENROLLMENT IN IMRF IMRF Form 6.10 (Rev. 11/05) Please print or type Use Black Ink. Please do not use a highlighter anywhere on the form. MEMBER INFORMATION (to becompleted by member please print or type) 1. Last Name 2. Social Security Number 3. Mailing Address City 4. Home Telephone No. ( ) First Middle Initial State ZIP+4 County 5. Birth Date: month/day/year Jr., Sr., II, etc. TAPE A COPY OF SOCIAL SECURITY CARD IN THIS SPACE If a copy of the Social Security card isnot attached, IMRF will usethesocial Security number entered onthis form. Any IRS penalties that result from anincorrect Social Security number will be the responsibility ofthe IMRF employer. (Do not staple card usetape and please stay within this border.) 6. Marital Status D Single D Married Q Divorced n Widowed 7. Gender O Female D Male 8. Are you currently participating or have you previously participated In IMRF or any other Illinois Public Pension systems? fl No n Yes (please check the box(os) toidentify the pension system^)] n IMRF (It indicating IMRF, are you currently collecting apension from IMRF? D Yes D No n Chicago Public School Teachers" D Cook County Annuity &Benefit Fund U General Assembly Retirement System r] Judges' Retirement System D Laborers' Annuity &Benefit Fund DCook County Forest Preserve Annuity &Benefrt G Metro Water Reclaim. Retirement System D Municipal Employees Annuity &Benefit Fund Park Employees' Annuity &Benefit Fund C State Universities Retirement System D State Employees' Retirement System G State Teachers'Retirement System Icertify that this information is correct to the best of my knowledge and belief. Employee signature (write; do not printor type) X EMPLOYMENT INFORMATION -ALL FIELDS MUST BE COMPLETED (to be completed by employer - please print or type) 9. Employer Name 10. Employer IMRF I.D. Number Date 11. Position Information Date employed Participation date* MO DAY Vn MO DAY YR (SLBP ONLY: Employee will participate in CIRCLE ONE) Regular ECO SLEP ( FT / PT) D Regular D ECO SLEP ( FT/ PT) Position Title(s) If date employed is earlier than participation date, explain in detail why the member was not enrolled immediately. The Illinois Pension Code does not recognize "probationary," "temporary," or "trial work period." Refer to Section 3of the Authonzed Agents Manual for details on participation requirements. 12. Will employee work in a seasonal position? No DYes OR Is employee an elected official who will be be paid irregularly? D No D Yes If employee will hold aseasonal position and the seasonal employer is not aschool district, park district, or recreation association, OR if employee is an elected official who will bepaid irregularly, check the months the employee will not be paid: LI Jan Li Feb 111 Mar D Apr D May C Jun D Jul Q Aug Sept Oct D Nov D Dec 13. Is employee: A. Policechiefeligible for transfer into IMRF forslep coverage? n No n Yes (attach Form 6.22) B. Performing policeduties? No Yes C. Performing fire protection duties? U No G Yes D. City hospital worker? D No n Yes (attach Form 6.21) Elected official or appointed to elected office? D No a Yes (attach Form 6.21) For County employers only: Has member elected to participate in the Elected County Offical (ECO) plan? L") No D Yes (attach Form 6 1B) Icertify this information is correct to the best of my knowledge and belief, and that the person named above isemployed in a position which qualifies him or her for membership in IMRF with the above employer. Authorized Agent signature (write; do not printor type) X IMRF Form 6.10 (Rev. 11/05) Illinois Municipal Retirement Fund 2211 York Road, Suite 500, Oak Brook Illinois Service Representatives ASK-IMRF ( ) Date

3 DESIGNATION OF BENEFICIARY IMRF Form 6.11 (Rev. 07/11) Questions? Call ASK-IMRF ( ). Who can complete this form We can accept the signature of the member only on this form. If someone other than the member signs this form, including an agent under a power of attorney, the form will not be accepted. If you make any changes to this form If you make any changes to your beneficiary information, you must initial the change. If you do not, the form will not be accepted. Benefits payable upon your death If you die while participating in IMRF, IMRF will pay your beneficiary(ies) a: a. Lump sum death benefit, which can be equal to one year s salary, plus a refund of the balance in your IMRF member account, OR b. Monthly Surviving Spouse pension, plus $3,000 (if eligible). [A child s pension is payable if you are participating in the Elected County Official plan, your spouse is not eligible for a surviving spouse pension, and you have single (unmarried or not in a civil union) children under the age of 18 at the time of your death.] How to complete this form Primary Beneficiary(ies) If you do not have a valid Designation of Beneficiary form on file with IMRF, your estate is automatically your beneficiary. If you want any other arrangement, you must submit a Designation of Beneficiary form to IMRF. You can name any person, church, trust, charity or organization. If your primary beneficiaries do not survive you, IMRF will pay the benefit to your Secondary Beneficiary(ies) or to your estate. Note of caution for married members or members in a civil union If you want to ensure that your spouse is eligible for a Surviving Spouse pension, you must name your spouse as your only primary beneficiary. If you divorce, your former spouse is no longer your beneficiary. If you want any other arrangement, you must file a new Designation of Beneficiary form. If you name more than one Primary Beneficiary The persons listed become co-beneficiaries and will share the lump sum death benefit according to the percentages you enter. If you leave the percentages blank, the persons listed will share the benefit equally. If you are naming someone under the age of 18 (a minor) Death benefits will be paid in care of the minor s guardian. If you want someone other than the guardian to receive the IMRF benefit on behalf of the minor, you may name a custodian, who is 21 years of age or older, under the Illinois Uniform Transfers to Minors Act. Enter the name of the individual you wish to appoint as custodian followed by as custodian for (name of minor) under the IUTMA. IMRF Form 6.11 (Rev. 07/11) page 1 of 2 continued on next page...

4 If you are naming a trust Please provide the number and/or date of the trust. Secondary Beneficiary(ies) Your Secondary Beneficiary(ies) will receive the death benefit payable by IMRF if no Primary Beneficiary survives. You can name any person, church, trust, charity or organization as your Secondary Beneficiary. You may also name more than one Secondary Beneficiary. Signature, date and returning the completed form You must sign, date, and file this form with IMRF for it to be effective. You can mail the completed form to IMRF directly, or you can give the completed form to your employer, who will mail it to IMRF. The information on this form does not become effective until it is on file in IMRF s Oak Brook or Springfield office, even if your employer has a copy. IMRF Form 6.11 (Rev 07/11) page 2 of 2

5 DESIGNATION OF BENEFICIARY IMRF Form 6.11 (Rev. 07/11) Please print or type use black ink and do not use a highlighter on the form. 1. Member Information Employee Name Mailing Address (street address; city; state; zip+4 if known) Social Security Number - - Birthdate (MM/DD/YY) Daytime Telephone No. ( ) Marital Status Single Married Civil Union Divorced Widowed Gender of Spouse Male Female Spouse s Last Name First Name Middle Initial Maiden (if applicable) Marriage/Civil Union Date (MM/DD/YY) 2. Primary Beneficiary(ies) (For your spouse to be eligible for a Surviving Spouse pension, he/she must be your ONLY primary beneficiary.) Refer to instructions if naming a minor or a trust. First Name Last Name Social Security Number Relationship % Share (optional) to each Important: If the total of all primary beneficiary shares does not equal 100%, IMRF will allocate equal shares totaling 100%. TOTAL 100% 3. Secondary Beneficiary(ies) (Will receive IMRF death benefits if no Primary Beneficiary survives.) First Name Last Name Social Security Number Relationship % Share (optional) to each Important: If the total of all secondary beneficiary shares does not equal 100%, IMRF will allocate equal shares totaling 100%. TOTAL 100% 4. Signature (write, do not type or print) of member only (Form will not be accepted if someone other than member signs form.) X Date Read the conditions on the reverse side. IMRF Form 6.11 (Rev. 07/11) Illinois Municipal Retirement Fund 2211 York Road, Suite 500, Oak Brook, IL ASK-IMRF ( ) Fax

6 Conditions of IMRF Designation of Beneficiary This is a brief summary of your IMRF death benefit provisions. Your rights and obligations as an IMRF member are governed by Article 7 of the Illinois Pension Code. This designation of beneficiary: Provides for payment of IMRF death benefits and revokes (cancels) any prior beneficiary designation. Will be effective when you sign it and it is on file in IMRF s Oak Brook or Springfield office. Is subject to Illinois law and to rules and regulations established by the IMRF Board of Trustees. The acceptance of this designation by IMRF does not mean that a death benefit will be payable if you are not otherwise entitled to one. Whether a benefit is payable, and the amount paid, will be determined at the time of death under applicable laws and regulations. You cannot name a creditor (such as a bank, credit union, or loan company) as your beneficiary as a means of providing security for a debt. Benefits payable Lump sum death benefit OR Surviving Spouse pension Child s pension A child s pension is payable if the member was participating in the Elected County Official Plan and the member s spouse is not eligible for a surviving spouse pension, but the deceased has unmarried children under the age of 18. Surviving spouse pension If you want your spouse to be eligible for a Surviving Spouse pension, you must name your spouse as your only Primary Beneficiary. If your spouse is not your only Primary Beneficiary, the right to a Surviving Spouse pension is forfeited (lost). only a lump sum benefit is payable (which can be equal to one year s salary, plus a refund of the balance in your IMRF member account). In the case of the member with many years of service credit, the forfeited Surviving Spouse pension may be of greater value than the lump sum benefit. Naming a minor(s) as beneficiary(ies) Death benefits payable to a minor (under the age of 18) are paid in care of the minor s guardian. If you want someone other than the minor s guardian to receive the IMRF benefit on behalf of the minor, you may name a custodian (who is 21 years of age or older) under the Illinois Uniform Transfers to Minors Act. This is done by entering the name of the individual you wish to appoint as custodian followed by as custodian for (name of minor) under the IUTMA. Shares to each named beneficiary If you name more than one person as beneficiary, they will share equally in the benefit unless you write in specific shares to each. If you write in specific shares (percentages), the benefit will be distributed as you directed. If a named beneficiary does not survive, his or her shares will be distributed among any surviving beneficiaries. However, if you want his or her shares to be distributed to his or her heirs by blood line (not a spouse), add per stirpes after the beneficiary s name. Death benefit payments IMRF death benefits are paid to your: Primary Beneficiary you designated on your most recent valid designation of beneficiary form on file with IMRF. Estate if you have no valid designation form on file. If none of your Primary Beneficiary(ies) survives, the benefit will be paid to your Secondary Beneficiary(ies). If none of your Primary or Secondary Beneficiary(ies) survives, the benefit will be paid to your estate. If you divorce If you named your spouse as a your primary beneficiary but you later divorce, your former spouse is no longer your beneficiary. If you want any other arrangement, you must file a new Designation of Beneficiary form.